Healthcare Provider Details

I. General information

NPI: 1316577398
Provider Name (Legal Business Name): IZABELA URBANIEC PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2020
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W SAINT GEORGES AVE
LINDEN NJ
07036-5638
US

IV. Provider business mailing address

47 VIOLET PL
EDISON NJ
08817-4543
US

V. Phone/Fax

Practice location:
  • Phone: 908-925-7519
  • Fax: 908-925-2842
Mailing address:
  • Phone: 732-801-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00546300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: